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Jolie's mastectomy puts focus on cancer treatment

By Emily Wax and Lena H. SunWashington Post

Posted:
05/14/2013 12:01:00 AM CDT

Updated:
05/14/2013 08:34:28 PM CDT

What does it mean when Angelina Jolie, the Hollywood actress and activist who epitomizes beauty and sexual power, tells the world that she's just had a double mastectomy? It's almost as if Marilyn Monroe announced she had her breasts removed.

"I started getting emails at 6 a.m.," said Eleni Tousimis, the chief of breast surgery at MedStar Georgetown University Hospital in Washington. "When such a beautiful woman and icon talks about this openly, it just changes everything."

The op-ed by Jolie, 37, in the Tuesday, May 14, New York Times about her decision to remove her breasts and therefore reduce her chances of getting breast and ovarian cancers, was in many ways more shocking than a cancer diagnosis itself, especially in a society in which a Hollywood superstar's appearance -- specifically Jolie's breasts -- is seen as a public commodity.

"On a personal note, I do not feel any less of a woman," she wrote. "I feel empowered that I made a strong choice that in no way diminishes my femininity."

Cancer survivors and others around the world took to social media to praise her decision "as brave and honest."

But skeptical voices ask if a celebrity, empowered by fame and wealth, could cause a rush of expensive testing, leading to panic and misinformation.

Well-known personalities who have spoken about the importance of getting tested and treated for prostate cancer, for example, "have done harm because the information they put forth is actually misinformation," said Otis Brawley, chief medical officer for the American Cancer Society.

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Jolie said that once she knew she carried a harmful mutation of the BRCA1 gene that gave her an 87 percent chance of developing breast cancer and a 50 percent risk of ovarian cancer, having surgery and reconstruction made it easier for her to reassure her children and her partner, Brad Pitt, that she would stave off cancer. Her mother died of ovarian cancer at 56.

The condition that Jolie has is a rare harmful mutation in a gene called BRCA1. Less than 1 percent of all women have a mutation in that gene or another one called BRCA2, Brawley said.

Mutations in the two genes are estimated to account for 5 to 10 percent of breast cancers and 10 to 15 percent of ovarian cancers among white women, according to the National Cancer Institute.

Brawley praised Jolie for showing "tremendous understanding of this disease and the problem of genetic mutation." Her op-ed was reasonable and science-based, he said.

But some cancer experts are worried that women and their families might hear only part of Jolie's message "and rush out and get an expensive test," he said.

The U.S. Preventive Services Task Force recommends that only women with a strong family history of cancer be evaluated for genetic testing for BRCA mutations. This group represents only about 2 percent of adult women in the United States, experts said.

Some mutations, like the one Jolie has, are linked to very high risks for breast cancer. Others are associated with a lesser cancer risk, still others are linked to risks of undetermined significance and a few mutations appear to be linked to no significant increased risk of breast cancer, Brawley said.

But Jolie's op-ed probably will inspire other women to find out more information and think about their choices, said Tousimis, of the MedStar Georgetown hospital.